Healthcare Provider Details

I. General information

NPI: 1447497003
Provider Name (Legal Business Name): STEPHANIE M HERRO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M SUTTMANN

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

PO BOX 636324
CINCINNATI OH
45263-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-4000
  • Fax: 859-301-4001
Mailing address:
  • Phone: 859-301-4000
  • Fax: 859-301-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012254
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number09768-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: